Cervical cancer with adverse biology / locally-advanced features predicting poor CRT resp...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CERVICAL-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-CERVICAL`
Sources	`SRC-ESMO-CERVICAL-2024` `SRC-NCCN-CERVICAL-2025`

Red Flag Origin

Definition	Cervical cancer with adverse biology / locally-advanced features predicting poor CRT response: bulky primary ≥4 cm, lymph-node-positive (pelvic and/or para-aortic), non-squamous histology (adenocarcinoma / adenosquamous), or PD-L1 CPS ≥1 in metastatic context (informs pembrolizumab + chemo per KEYNOTE-826).
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "primary_tumor_size_cm",
      "threshold": 4
    },
    {
      "finding": "lymph_node_positive",
      "value": true
    },
    {
      "finding": "para_aortic_node_positive",
      "value": true
    },
    {
      "finding": "histology_non_squamous",
      "value": true
    },
    {
      "all_of": [
        {
          "finding": "metastatic_disease",
          "value": true
        },
        {
          "comparator": ">=",
          "finding": "pdl1_cps",
          "threshold": 1
        }
      ]
    }
  ],
  "type": "composite_clinical"
}

Notes

Para-aortic-node-positive: extend RT field to PA + pelvis (per ATIVE/RTOG data). Bulky ≥4 cm or LN+ : INTERLACE trial (Lancet 2024) — induction carbo+pacli x6 weeks then standard CRT improves OS (~5% absolute at 5y); ESMO 2024 update endorses for fit patients. Adenocarcinoma: poorer CRT response than squamous; same regimen but lower cure rate — counsel early consolidation considerations. PD-L1 CPS ≥1 metastatic: pembrolizumab + carbo + pacli ± bev (KEYNOTE-826 — OS HR 0.67).

Used By

No reverse references found in the YAML corpus.